How We Diagnose Testicular Cancer

How We Diagnose Testicular Cancer

Testing for testicular cancer

What to expect during your appointment: exam, blood test and ultrasound

First, the doctor will examine your testicles for lumps or swelling.

A blood test will be performed to test for certain proteins in your blood. These proteins are called tumor markers and can be used to diagnose testicular cancer.

If the doctor thinks that you may have testicular cancer, the next step is to have an ultrasound, a quick and painless scan that looks at the inside of your testicles. Normal testicles are smooth and even. Shadows on the ultrasound usually indicate that a cancer is present. The ultrasound also measures blood flow to the testicles, since blood flow is usually increased in the area of a cancer. The experienced ultrasound specialists at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) understand some men may have anxiety about having an ultrasound; they will explain the process and help to ease any anxiety.

Urology

If your blood test is positive for testicular cancer tumor markers, or if your ultrasound reveals a cancerous-appearing lump in your testicle, you will be referred to a specialist called a urologist. Urologists are surgeons who focus on the urinary tracts of males and females, and on the reproductive system of males, including problems with the testicles. For patients with testicular cancer, a urologist will perform the surgery to remove your tumor.

Diagnostic surgery

Unlike other cancers for which a biopsy (the removal of a sample of cells for examination) is performed, when testicular cancer is suspected the entire testicle is removed in a procedure called an orchiectomy through an incision in the groin and pulling the testicle up from the scrotum. A biopsy through the scrotum for testicular cancer runs the risk of spreading the cancer, and can complicate future treatment options. Removing the entire testicle out of the scrotum is the only safe way to diagnose for testicular cancer. Only the cancer-containing testicle is removed, and it is important to do so promptly. Our urology team will make this a priority for you. If there is any uncertainty, the urologists can examine the testicle by pulling the testicle out of the scrotum; if a condition other than testis cancer is found, the testicle is placed back into the scrotum.

This may sound frightening, but recovery is quick. And do not worry — the remaining testicle can do the work of two. Please understand that removal of the testicle will not make you sterile (unable to have children) and does not take away your ability to enjoy sexual activity or have an erection.

Pathology

The removed testicle will be sent to our pathology laboratory for a thorough examination under a microscope. A pathologist is a specially trained doctor who identifies cancerous cells and tumors. DF/BWCC pathologists are well-known for their expert evaluation of testicular cancer. They will diagnose and classify your cancer quickly and competently.

Most testicular cancers are classified as germ cell tumors. This is not an infection. Instead, the term germ cell reflects the fact that testicles make sperm. Germ cell tumors are divided into two types: seminoma and nonseminoma.

Seminoma tumors are the more common kind of testicular cancer. They are usually limited to the testicle but occasionally spread to other parts of the body. Seminomas tend to grow very slowly and are very curable.

Nonseminoma tumors can grow more quickly and can be more likely to spread beyond the testicle to other parts of the body. While these tumors are curable, men with nonseminoma tumors are more likely to require chemotherapy at some point in their treatment.

Another test to expect if you are diagnosed with testicular cancer

In order to decide what treatment is best for you, it is important to know whether or not your testicular cancer has spread beyond the testicle. Another kind of scan can be used to look for cancer in other parts of the body:

A CT scan (also known as a CAT scan) is a painless procedure that takes a series of detailed x-ray pictures inside the body from different angles. The CT scan is quick and painless and will look at your abdomen and chest. The results are usually ready in just a few hours.

Our experienced radiologists will review your scans to help determine the stage of your cancer.

The stages of testicular cancer

Testicular cancer is divided — or staged — into groups based on how far the cancer has spread to other parts of the body. Here are the basic stages for testicular cancer:

Stage 1 means that the X-rays/CT scans do not show any evidence of cancer beyond the testicle. This stage is cured more than 99% of the time.

Stage 2 means that the CT scan has identified cancer that has spread beyond the testicle to the lymph nodes in the abdomen. These lymph nodes are usually located in the area near large blood vessels. Stage 2 testicular cancer is also very curable.

Stage 3 means that the cancer has spread beyond the testicle and abdominal lymph nodes to additional areas in the body.

Stage 3 can mean that the cancer has spread to the lymph nodes in front of the heart or to the lungs. Stage 3 testicular cancer is also very curable, but may require more treatment than Stage 2.

Stage 3 can also mean that the cancer has spread to areas beyond the lungs and lymph nodes. Lance Armstrong was diagnosed with Stage 3 testicular cancer in 1996. His cancer had spread to his lungs, stomach and brain. He has been cancer-free since 1997. With proper treatment, even more advanced Stage 3 testicular cancer can be cured.